Wednesday, May 9, 2012

In this post, I'll analyze the decisions faced by a would-be suicide under the kind of suicide prohibition in force in developed countries today. The modern suicide prohibition can be summarized as follows:

Anyone caught attempting suicide will be hospitalized in a degrading, humiliating manner.

Anyone caught attempting suicide will have his injuries forcibly treated and will be kept alive against his will.

Since barbiturates are illegal, available suicide methods mostly require inflicting extremely unpleasant trauma on oneself, such as by jumping off a tall building, shooting oneself in the head, cutting one's arteries, or hanging oneself.

A person who attempts suicide by trauma and fails may experience sequelae that render his quality of life much worse than the original worse-than-death quality of life he experienced before the attempt.

A person who attempts suicide by trauma and fails may render himself unable to end his life in the future because of injury.

Anyone who renders assistance to the suicidal person (such as by holding the dying person's hand and watching to make sure the person dies as planned) may be prosecuted for the crime of assisting a suicide.

It is often convenient for cheery folks (and even cranky old Richard Posner) to model the decision to commit suicide as if the only variable were expected quality of life pre-suicide, and to implicitly treat the probability of successful suicide (given an attempt) as 1. If future quality of life (summed over the expected lifespan) is less than zero (and present quality of life is less than zero), one should, in this naive view, commit suicide; else don't.

This naive model ignores the considerations outlined above: given even a small probability of failure, the downsides to failure (injury, paralysis, hospitalization) may make it rational to suffer through a quality of life that is significantly worse than the zero-value of death. In fact, the unpleasantness of the method itself may have this effect as well (I am certainly not looking forward to jumping off a bridge if it comes to that; would you want your sick grandma to have to do that?).

Many Choices

Another aspect of the problem is that the would-be suicide faces not just a single decision (suicide or no), but a never-ending series of decisions: suicide
now, or wait an interval of time and face the same problem again after that interval. Again, given either a nonzero chance of failure or extreme unpleasantness of methods available, and on the other hand given the possibility of future change (e.g., you might meet a shady character with access to the appropriate pharmaceuticals), it may be the welfare-maximizing choice even for a suffering individual to stick it out for another day. In the moment, the cost of waiting another day might rarely exceed the cost of jumping off a bridge, or the (negative) expected value of the small probability of
waking up with akinetic mutism
while medical experiments are performed on one.

The Only One That Wakes Up Is You

Ordinary calculations of the expected value of continuing to live versus making a suicide attempt assume high comparability between the zero-state of successful death and the hugely negative welfare one would experience if one were to survive an attempt. There is an important intuitive difference: if successful,
no one
experiences the (desirable) zero-value of death; your experiencing self simply stops. On the other hand, if the attempt fails, someone - YOURSELF - experiences the misery of post-attempt hospitalization, injury, paralysis, and the like.

In Denis Johnson's novel
Already Dead: A California Gothic, a suicidal character walks into a pond to drown himself, but is unexpectedly "rescued." From this, he concludes that he will exist perpetually, that his conscious, observing self will somehow find the path among the Many Worlds that allows him to survive - a bit like the narrator in Greg Egan's novel
Quarantine, minus the quantum trappings. In a less mystical sense, if you attempt suicide, the only future you can expect to wake up into is a future in which you have failed. The only future self that exists is the suffering future self of the worst case scenario. Even if this is a mathematically tiny probability, it is the only future self that exists - the same you who longs to shrug off the present suffering would bear the heavy consequences of failure. (There is something about a conscious observer waking up that boggles the mind, as Sleeping Beauty halfers and thirders alike must admit.)

A suicide wants to avoid the suffering he experiences now. But if he fails, he will have made it much worse; and the only future he'll be awake for is the one in which it's much worse. In an environment of suicide prohibition, we cannot be at all certain that the people walking around today experience positive utility. Many people who experience extreme suffering and want to die nonetheless
rationally
choose to keep living, under the current regime. Isn't the reason for all this prohibition precisely that society expects many people to have expected utility so low that they want to die?

For those concerned with suffering, comfortable suicide is low-hanging fruit. If we ended the suicide prohibition to (a) allow comfortable, reliable suicide by barbiturates and (b) decriminalize the "assistance" of suicide,
we could be much more certain that people are alive because they genuinely want to be. The easier it is to exit, the less harmful is the creation of a conscious entity.

27 comments:

Isn't the reason for all this prohibition precisely that society expects many people to have expected utility so low that they want to die?

No, the reason is that many people don't calculate expected utility and then maximize it perfectly rationally. They are presumed to act impulsively, in the midst of a complete statistical outlier mood that can be easily cured with some meds or therapy, or that at least has a generally high probability of turning into positive utility once more, which will then last for several more decades. Combined with anecdotals of people who were once suicidal and now superhappy.

And you know what, that's actually a benevolent stance, assuming that these assumptions are typically true. The rest is overgeneralization and religious taboos. And if you're never happy, surely your 5th suicide attempt will finally kill you?

From this, he concludes that he will exist perpetually, that his conscious, observing self will somehow find the path among the Many Worlds that allows him to survive

Yes, but the total fraction of worlds in which he suffers is greatly reduced, therefore the total amount of his suffering in the multiverse is thinned.

Since barbiturates are illegal, available suicide methods mostly require inflicting extremely unpleasant trauma on oneself, such as by jumping off a tall building, shooting oneself in the head, cutting one's arteries, or hanging oneself.

This ignores helium and CO methods, which may require annoying preparation and still have failure modes, but which can be performed without physical trauma, and with survival modes that mostly leave the person intact enough to attempt suicide again, if only after a few months of wearing the mask of the successfully compliant therapeutic patient.

Ah okay. Agreed - gas doesn't require trauma (might not even be that bad - a friend of mine died from nitrous allegedly accidentally), though I've read reports of folks on the dark kinds of forum who've tried and not been able to make it work. Breathing stuff that's not air is apparently not possible for everyone. But it's better than a knife, maybe about equal with a bridge, in terms of scariness (subjectively).

Well, I've obviously never tried it myself. But I've prepared it and I'm trying not to lament the suicide prohibition too much until I actually try the helium method once. And obviously I'm going to do that only when I actually really want to die.

The "waiting time" with the inhalation methods is traumatizing -- and also increase the chances of "rescue" considerably. Besides, it seems your brain can get permanently affected if you deprive it of oxygen for long enough. It might leave you
physically
capable of attempting suicide again, but messing up with our brain is scary -- scarier than many kinds of physical pain.

I don't know about the details of barbiturates, but well, I at least don't think you can be "rescued" from a lethal dose ... Not sure. In fact, a suicide might themselves get scared (yes!) and pull themselves out of suffocation, but to pull out the instilled barbiturates must be a medically involved process.

But these inhalation methods must be kind of good, since they're used for pet euthanasia.

What do you think of opioid overdose as a suicide method? Heroin or morphin are easier to acquire than barbiturates. Or if even these are too expensive or difficult to find, then even opium (plain poppy sap) will do the job. Opioids have analgesic and narcotic effects (they even make you feel quite cosy emoionally) and since apparently you only stop breathing after becoming unonscious, it looks to me like a relavitely painless way to die. And from what I've read if you survive it doesn't usually leave you lasting side effects. Can you find any faults with his method that I can't see?

From my research, opiates don't work very well on their own (actually really hard to overdose) - UNLESS combined with alcohol or other substances. One theory is that the hemlock (Conium maculatum) that sent Socrates off was mixed with opium. Janice Joplin's heroin overdose was combined with a huge amount of alcohol. So it's a possibility. If I could get it in my network I'd seriously consider it; perhaps it's an avenue to explore. For whatever reason, eating/smoking a substance is much more palatable to me than trauma or breathing an inert gas. I've heard you can make opium tea from poppies available dried in flower markets.

The authors of Final Exit don't seem to take the method very seriously, but it might just be that it has to be combined with alcohol to be effective.

The guy in the This American Life episode I write about
here
tried opiates once and failed but then tried them again and succeeded.

"Ah okay. Agreed - gas doesn't require trauma (might not even be that bad - a friend of mine died from nitrous allegedly accidentally), though I've read reports of folks on the dark kinds of forum who've tried and not been able to make it work. Breathing stuff that's not air is apparently not possible for everyone. But it's better than a knife, maybe about equal with a bridge, in terms of scariness (subjectively)."

What about:

- dopamine antagonists (such as metoclopromide and prochloreperazine -- as short-term anti-emetics to prevent vomiting up the toxic drugs, and as pro-kinetics, to speed their passage out of the stomach and into the small intestine for absorption)- a tricyclic antidepressant (preferably amitriptyline for its greater sedating effect and toxicity -- to cause cardiomyopathy leading to death by arrhythmia)- a cytochrome P450 SD6 weak antagonist (such as cimetidine: to raise serum levels of tricyclic antidepressants thus decreasing both time to death and potential survivability)- a long-acting benzodiazepene (such as diazepam: for humanity, and as a long-acting anti-emetic)- a short-acting benzodiazepene (such as lorazepam: for humanity, and as a medium-acting anti-emetic)- alcohol (for humanity, for reminiscing on good times, and to increase the effectiveness of tricyclic antidepressants)

?

My understanding from reading
Guide to a Humane Self-Chosen Death, the
wiki here (plus following relevant links), and the info on Amitriptyline and Cimetidine at the
People's Pharmacy,
is that the above in sufficient dosages for bodyweight should be both lethal and humane (provided one is clean of any of the sedating drugs for the prior month so as to have removed any built-up tolerances to them).

If stopping someone from committing suicide furthers that person's values, I've said I'm all for it (re:
force feeding anorexics
and intervention in suicide in general). However, a general social prohibition is hardly the way to do it. (That 5th attempt might never come, for reasons mentioned above.)

Why not allow people to opt out of suicide "protection" while competent, for instance? Or to suicide comfortably
after a, say, 6-month waiting period? These options would better serve the interest of preventing only impulsive suicides than an outright ban. The fact that these aren't even close to our laws should make us suspicious that this is the real reason behind the prohibition (or its main function). Another thing that should make us suspicious is how far back in time the suicide prohibition goes - long before our medical model (and they used to punish attempts by hanging). The universality and long duration of the prohibition should make us question whether the modern justification is the actual justification, and the modern supposed consequence is in fact its main consequence.

we could be much more certain that people are alive because they genuinely want to be. The easier it is to exit, the less harmful is the creation of a conscious entity.

I'd be careful here. If suicidality is a temperamental trait governed -- to whatever extent -- by biology (yes), it may turn out to be less relevant than we assume as a signifier of the subjective value individuals assign to their continued existence. If there are constitutionally non-suicidal people who are predisposed to suffer (profoundly) yet endure, the intuitive certainty that the initial harm of procreation is mitigated by "free disposal" could be a dangerous mistake.

Agree - it won't make it okay, but it will make it better for people like me. I find it telling that none of the libertarian Bryan Caplan types who are so sure there is free disposal spend any effort at all arguing for suicide rights.

It would seem that suicide is the most basic right a human has. The pro-choice people in the abortion debate talk about a woman's right to choose. What about our choice to end our own lives, when not even another proto-human is even at stake.

Why don't you anti-suicide people all start talking about how horribly selfish she was?

Oh wait. There's a little detail that gets in the way of that narrative. You see, she was raped again and she couldn't handle it. She was raped by her new boyfriend. I was jealous because she told me he was sweet.

By raped "again" what do I mean exactly?

Well, she was only raped once before in this lovely world of ours. If you can say "once" to being gang-raped by 6 older students at the age of 15. How do you count that really?

So she was raped twice or seven times, however you look at it. And she did the one thing she could do — the
only
thing she could do — to make sure she would never be raped again.

She mentioned me in her suicide note. To say hi to me and that she loved me and I loved her.

Last night I drank at two bars. I drank and cried. Balled really. Balled a lot.

I didn't know people did that at bars. Probably they don't, not often. Not in public. Not men anyway.

But I did. I drank and threw up on my shirt and the bathroom floor. I never made it to the toilet.

I woke up with urine beside my bed. Mine presumably since I was alone. I vaguely remember that.

I felt sick and walked to the store to get some food. I threw up twice on the way there.

I didn't smell my stench until I walked in the store. The contrast between the clean air and my drunken vomit was immediate and powerful. I ate potato salad, lots of.

Stomach quieted, I walked back. I then read the news, about Canada's recent gruesome murderer, and the video of him, naked, stabbing and disembowelling a guy, and raping his dying body and corpse. He mailed one of his feet to the HQ of the Conservative Party of Canada and a hand to the Liberal Party of Canada. The torso was in a fluid-leaking smelly suitcase outside the apartment. The apartment smelled of rotting meet and was covered in blood but he passed his credit check, and that's what matters these days, eh? So yay for that.

He was wanted by animal rights groups for posting cat torturing and killing videos online and had a relationship with the ex-wife of Canada's most notorious serial killer and serial rapist — she drugged her younger sister so her hubby could f— her sister, whereupon she vomited and died, if I remember right. Oh, and they captured, raped, and killed other girls so it wasn't just
her own
sis. She's free now, by the way.

Canada's more recent killer is also gone. Police don't know where he is. He wrote internet articles on how to set up a new identity and disappear. The killing was in Montreal: he's thought to be in France now. Who knows?

Oh, and my beloved friend's seven rapists? They're all still alive too. I'm sure they'll again have the pleasure of putting their d-cks inside other unwilling women.

There is no justice in this world. None of this is fair. It's not right. She was a lovely girl who liked to dance and smile and be nice to people and laugh lots and eat and swim and do handstands and support you when you felt bad. But she didn't want to be raped anymore.

Go ahead, pro-forced-life people. Tell me how selfish my friend was for killing herself. Tell me how "mentally ill" she must have been for wanting to leave THIS lovely world filled with these amazing people. Tell me what a coward she was for hanging herself knowing that her neck would break or she would painfully strangle to death.

She did the one thing that would guarantee that wouldn't happen to her again.

How do you, I, or anyone know we won't be being tortured in a serial killer's basement tomorrow? Or beaten up on the street or get cancer (30% of people do). Or be left by those we love (or watch our friends die). And so on.

It's "irrational" to want to commit suicide? You expect me to buy that?

P.S. There are many ways you can look at life and many ways I have done. Some of them are sweet and beautiful, I don't deny that. But ... it isn't just that. Far from it. Life is vomit and urine and rapes and torture and murder and lies and loss. And I think sometimes a person can only take so much of those, especially factoring in the chances of some or all of them happening in the future. Not everyone can accept the risk of that much pain. For those that can't, they should be allowed to leave. And they shouldn't have to go through the final horror of breaking their necks or strangling or choking or shooting thesmelves and risking being an in-pain vegetable for decades. Please let people who are in pain and can't take it die at least as well as a DOG. Let them have barbiturates and even say goodbye to their loved ones. No more walking in on people hanging ... and being angry at THEM. They had their reasons. They're usually good ones.

Now that I have finally managed to procure the right drugs for a peaceful death, suicide doesn't seem hadr anymore. In fact knowing I have the drugs in the cupboard keeping them for when the time feels right is a bit like knowing I have a cake in the fridge and trying not to eat it until a later date.